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Wiki PA Billing help
- Thread starter bill2doc
- Start date
As @jkyles@decisionhealth.com stated, that question is key. In my personal experience, even if it is planned for the PA to work only incident-to, there will likely be situations where that doesn't occur. Examples: carrier does not follow incident-to, patient seen by PA for new issue or worsening problem, patient calls with an urgent issue while physician is unavailable, physician is sick or on vacation.
Regarding codes for a PA, the codes are the same as billing for your physician. The main issue is credentialing. You should immediately start contacting your contracted payors to find out if they credential PAs (most do) and how to get the PA participating ASAP. You don't want to have your PA start, but you are unable to bill their services.
Regarding codes for a PA, the codes are the same as billing for your physician. The main issue is credentialing. You should immediately start contacting your contracted payors to find out if they credential PAs (most do) and how to get the PA participating ASAP. You don't want to have your PA start, but you are unable to bill their services.
amyjph
True Blue
Please consider searching the forums for this, I believe there are many threads with this information. There are also many variables/scenarios to this so it's difficult to answer such a broad question.
@csperoni @amyjph Thank you all for your response. @jkyles@decisionhealth.com The office would like to bill Incident-to (which I have learned this is under the provider NPI/Tax number) I'm just unclear if the PA NPI or Tax ID is on the HCFA 1500 at all in this instance. The provider is wanting to be in office and have PA work under her and pay PA a salary but I don't know how the HCFA 1500 is set up so that we get paid 100%. It seems odd to me that the PA would do some of the work but not be on the claim form however it seems if they are on the claim form it would reduce the payment...??? I understand what you all mean about credentialing the PA so that in the case they need to bill themselves they can. Can anyone help me with the HCFA set up for both incident to and direct bill. Boxes J, 31 and 33 most specifically. Thank you very much!
If you are billing incident-to, the claim goes to your payor exactly as though your physician provided the service personally, hence the several requirements. I recall a few years ago one carrier wanting a specific modifier (maybe -SA) on the physician's claim. This is a payor policy only.
If you are not billing incident-to, then J & 31 have your PA's name and info. It's been a long time since I've set up CMS1500 forms, but I think 33 can be either the PA or the group, depending on how your practice is set up.
I just want to stress again that even practices that think their NPPs will only be incident-to are mistaken. Incident-to is a Medicare guideline not followed by all payors. Or your physician is off and a patient calls in the morning with a sore throat. Of course your PA is qualified to see and treat them. But it can't be incident-to. Patient with hypertension is coming in for BP check & Rx renewal being seen by PA. During the visit patient mentions left knee has been stiff with limited ROM and would like PT. In order to bill that visit incident-to, your PA would have to interrupt your physician, physician would have to actually see and evaluate the problem, not just stick their head in or co-sign the note.
It is possible to have a PA that is only incident-to, but you are then significantly limiting what the PA can do, and IMHO defeating the purpose of hiring the PA.
If you are not billing incident-to, then J & 31 have your PA's name and info. It's been a long time since I've set up CMS1500 forms, but I think 33 can be either the PA or the group, depending on how your practice is set up.
I just want to stress again that even practices that think their NPPs will only be incident-to are mistaken. Incident-to is a Medicare guideline not followed by all payors. Or your physician is off and a patient calls in the morning with a sore throat. Of course your PA is qualified to see and treat them. But it can't be incident-to. Patient with hypertension is coming in for BP check & Rx renewal being seen by PA. During the visit patient mentions left knee has been stiff with limited ROM and would like PT. In order to bill that visit incident-to, your PA would have to interrupt your physician, physician would have to actually see and evaluate the problem, not just stick their head in or co-sign the note.
It is possible to have a PA that is only incident-to, but you are then significantly limiting what the PA can do, and IMHO defeating the purpose of hiring the PA.